Largest ever whole-of-population study on the impact of TB and HIV interventions on the burden of TB launched in sub-Saharan African communities

Friday, 23 March 2018 (London, UK) – A new EUR 12.9 million project has been launched, measuring the impact of a combination TB and HIV intervention when delivered to the entire population of 14 urban, high-prevalence communities in South Africa and Zambia.

TB and HIV are the leading infectious causes of death worldwide – in 2016 1.7 million people died of TB. For people living with HIV, TB is the most significant co-infection, 40 percent of HIV deaths in 2016 were due to TB. The TREATS project [Tuberculosis Reduction through Expanded Anti-retroviral Treatment and Screening] was developed in response to this.

“TREATS is a unique opportunity to assess a combined TB and HIV intervention on a massive scale,” said Dr Helen Ayles, TREATS Project Director, Professor of Infectious Diseases at London School of Hygiene & Tropical Medicine and Research Director at Zambart. “It will provide amazing data and hopefully some practical solutions to end TB. TB is a curable illness, but in order to better reach people with treatment, we need to understand the epidemiology of the disease better. This is true active case-finding.”

TREATS aims to inform new policies and approaches for tackling the TB / HIV epidemic. As the global health community works towards ambitious new goals to end TB, TREATS will provide invaluable new information for accelerating effective interventions.

TREATS is being conducted by a consortium of organisations that is already running the largest ever trial of a combination HIV prevention strategy, known as HPTN 071 (PopART). This trial is being conducted across 21 communities in Zambia and South Africa, covering around one million people in total. PopART involves universal testing and treatment for HIV through house-to-house visits on an annual basis over four years – from 2014 – 2018. As part of PopART, all community members are also screened for TB.

Building on PopART, TREATS will measure the impact of this combined TB / HIV intervention on tuberculosis – measuring prevalence of disease as well as incidence of infection. The project runs until 2021 and includes: a social science component to better understand stigma related to TB; mathematical and economic modelling to provide answers for how future large-scale interventions can be undertaken effectively; use of the newest tools available for diagnosing TB infection and operating effectively on a large scale.

The HIV Prevention Trials Network (HPTN) 2017 annual meeting brought together researchers from its clinical trials involved in HIV prevention in countries across the world. Zambart, is part of a consortium of international researchers currently conducting the world’s largest HIV prevention trial in 21 communities in Zambia and South Africa.

The Zambart Community Engagement (CE) team on the HPTN 071(PopART) Trial won the Best Community Engagement Award for outstanding performance in mobilising the biggest community randomised HIV prevention study in the world. During the course of the four year study, Zambart’s CE team has developed novel strategies to engage, sustain, and work together with other study groups to increase participants for the trial, including ancillary studies nested with the main trial.

On August 15, 2017 Zambart joined other health stakeholders and participated in the annual HIV Testing, Counselling and Treatment (HTCT) Day event spearheaded by the Ministry of Health (MoH). National HTCT Day (previously National VCT Day) is held to raise public awareness on HIV prevention and treatment. During this year’s event, the President of Zambia Edgar Lungu announced the government shift to routine HIV testing and treatment in all health facilities in the country.

Zambart’s objective of participating in this event was to support HIV prevention and treatment, and showcase some of the organisation’s innovative activities aimed at enhancing uptake of HIV testing and treatment.

Across all its research sites on the Copperbelt, Central, Lusaka, and Southern provinces, Zambart field teams mobilised and conducted various community engagement and sensitisation activities in different zones, and participated in the district-level commemorations held under the theme: “HIV Test and Treat: Towards Ending AIDS”. The activities were also aimed to increase awareness about HTCT Day.

On March 24, 2016, Zambart joined the rest of the country in commemorating World TB Day. Across different study sites in Lusaka, Copperbelt and Southern provinces, Zambart staff under the on-going HPTN 071 (PopART) study engaged in different awareness – raising activities in the local communities.

Tents were mounted in select areas where CHiPs were positioned to specifically target the youth and adolescents.

TB Corner staff and Community Advisory Board Members (CAB), PopART study implementing partners and district health staff in some study sties, joined the CHiPs in the community awareness-rising campaigns.

Zambart staff took the lead and screened for TB first as well breaking down barriers by submitting sputum for examination.

Communities in all the PopART study intervention sites were involved in the World TB day commemorative activities. These include: Chimwemwe and Ndeke in Kitwe; Chifubu in Ndola; Makululu in Kabwe, Kanyama and Chipata in Lusaka, and Maramba and Dambwa in Livingstone.

For the last few years we have been working on some research projects that have focused on how diabetes affects tuberculosis in Lusaka (The DARTZ studies). Through this work we have met many people who are living with diabetes and we have listened to their stories. We have heard story after story about the difficulties and barriers that individuals living with diabetes face in Lusaka. Stories of years of multiple visits to clinics with diabetes symptoms before a diagnosis is made. Stories of young people with severe complications because they haven’t been able to access adequate treatment. And we have seen patients die in their twenties and thirties from uncontrolled, untreated diabetes; deaths that could have been prevented with long-term adequate treatment. Tuberculosis has a structured and coordinated service for diagnosis and treatment that exists throughout the country, but diabetes lacks even basic national guidelines for its management. We therefore wanted to help to raise the profile of diabetes and decided to do this through the use of cartoons.

We invited some people living with diabetes to join a small workshop. Six participants attended. During the workshop we discussed the difficulties and challenges that result from living with diabetes. The main challenges that emerged during the workshop were accessing care at the clinic, accessing appropriate food products and accessing accurate information about diabetes. We invited a cartoonist, Kiss Brian Abraham, to observe the workshop and draw some cartoon pictures based on the discussions throughout the workshop and with the involvement of the workshop participants. We then used the cartoon pictures to inform the wider public about diabetes and raise the profile of some of the challenges facing people living with diabetes. We hope that this will help to provoke solutions to be found for these challenges and ultimately help to improve the lives of people living with diabetes in Lusaka.

In recent past, Kanyama Clinic, a government-run health facility in Lusaka district was elevated from being a basic health care clinic to First Level Hospital status. This led to the hospital to host a colourful Open Day event on Tuesday 26th November, 2013 at which it showcased its facilities and services to the community. Kanyama is the largest and most densely populated communities in Lusaka.

The Open Day saw various organisations that operate at the hospital offering different health care services participating in the event. They exhibited their respective services that they offer to the public. Zambart is among the various implementing partners working with the Ministry of Health (MoH), and Ministry of Community Development, Mother and Child (MCDMCH) in disease diagnostics, treatment, prevention and control who operate from Kanyama Hospital.

The partners comprising different health non-governmental organisations, research organisations, community-based organisations including the Neighbourhood Health Committee used the Open Day occasion as an opportunity for community engagement and awareness-raising on different health issues. The distributed flyers and information leaflets and had on display posters and banners to sensitise the community on health matters. The also hospital gave free medical check-ups to the public that included blood pressure checks and sugar-level tests.

Lusaka District Health Management (LDHMT) Team Director Dr. Masumba Masaninga, was Guest of Honour. Dr. Masaninga addressed the audience on various health and medical issues, and took time to visit all information booths for the different departments at the hospital and for the partners operating from the hospital.

Kanyama hospital in collaboration with various implementing local and international partners provides community-based disease control programmes for Malaria, Diarrhoea, Cholera, Dysentery, TB screening and treatment, HIV prevention and treatment. Other services include the Out-Patients Department, Voluntary Country and Testing, Medical Male Circumcision, Prevention of Mother-To-Child Transmission of HIV (PMTCT), and other Safe Motherhood programmes, Dental, etc.

The Open Day was characterised with different activities that included thematic drama performances, song and cultural dances.

Zambart and its collaborating partner Centre for Infectious Diseases in Zambia (CIDRZ) in the Phase IIb trial of a new tuberculosis vaccine awaiting activation, held a two-day training for TB community advocates at Lusaka’s Cresta Golfview Hotel.

50 community engagement advocates drawn from various community based organisations in Lusaka’s Kanyama and Kalingalinga compounds, the study sites for the vaccine trial, attended the workshop, which was aimed at strengthening community engagement and advocacy capacity on TB treatment.

The trial also called TB 018, is being jointly conducted by Aeras and GlaxoSmithkline Vaccines, S.A. (GSK), and is a double-blind, randomised placebo-controlled study. Overall, the trial will enrol more than 3500 healthy adults, with latent (asymptomatic) TB infection (LTBI), ages 18-50 in three sub-Saharan African countries namely Zambia, Kenya, and South Africa.

Zambart has been conducting various clinical trials in TB in Zambia and beyond, for over 2 decades now.